Pathology/Lab Coding Alert

Question: A physician ordered a hepatitis C screening test for a Medicare patient with no known risk factors. How should I code the test?

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Answer: Medicare covers a one-time hepatitis C virus (HCV) screening for patients without symptoms of disease who were born between the years of 1945-1965.

Medicare also covers HCV screening for patients presenting with any of the following conditions:

• Persons with a history of sexually transmitted infections (STI)
• Persons with risky sexual behavior
• Human Immunodeficiency Virus (HIV) infected persons
• Persons having usage history of injected/non-injected illicit drugs
• Persons that belong to or have traveled to regions/countries with high or intermediate prevalence of
• hepatitis A virus (HAV) or hepatitis B virus (HBV) infection
• All pregnant women including those with a sexually transmitted infection (STI).

For screening a Medicare patient of the appropriate age or conditions, report G0472 (Hepatitis C antibody screening, for individual at high risk and other covered indication[s]).

To show medical necessity, choose an appropriate diagnosis code such as V73.89 (Special screening examination for other specified viral diseases), V73.99 (Special screening examination for unspecified viral disease), or V75.9 (Screening examination for unspecified infectious disease).

If the patient reports increased risk factors, such as past or present injection drug use or multiple sexual partners, you can list V73.89 as the primary code and additionally report V69.8 (Other problems related to lifestyle) or V69.2 (High-risk sexual behavior) as the secondary diagnosis.

Under ICD-10, you can code the reason for the test using a code such as Z11.59 (Encounter for screening for other viral diseases) or Z11.9 (Encounter for screening for infectious and parasitic diseases, unspecified).